Healthcare Provider Details

I. General information

NPI: 1992780464
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SUNSET PLACE MEMORIAL MEDICAL CENTER HEALTH & REHABILITATION
NEILLSVILLE WI
54456
US

IV. Provider business mailing address

216 SUNSET PLACE MEMORIAL MEDICAL CENTER HEALTH & REHABILITATION
NEILLSVILLE WI
54456
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3101
  • Fax: 715-743-6245
Mailing address:
  • Phone: 715-743-3101
  • Fax: 715-743-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT POLENZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-743-3101